Cataract grading systems: a review of past and present

Anterior chamber retained lens fragments: A novel approach with Nd:Yag laser

METHODS

Multicenter retrospective case series of nd:Yag laser fragmentation of LF in twenty eyes at different clinics discovered after cataract surgery performed through phacoemulsification and implant of intraocular lens (IOL).

CONCLUSION

Early nd:Yag laser procedure is a good option to use for retained lenticular fragments in the anterior chamber after cataract extraction, to reduce damages to the endothelium caused by the LF, to lower patient discomfort to re-enter surgery, to minimize costs of surgical re-intervention and to avoid possible inflammatory complications given by the retained fragments that may not be reabsorbed properly and may even present several years after primary surgery leading to damages to endothelium caused by the lenticular fragments and visual disturbances.

Efficacy and safety of Adrenaline-augmented subconjunctival anesthesia in phacoemulsification: A randomized controlled trial

BACKGROUND/OBJECTIVES

Cataract surgery, particularly phacoemulsification, has evolved significantly, benefiting millions worldwide. The choice of anesthesia technique impacts patient comfort and procedural efficacy. Subconjunctival anesthesia has emerged as an attractive alternative due to its potential to provide effective pain relief and surgeon comfort during surgery. A different aspect of this study is the inclusion of 1:100,000 adrenaline in 2% lignocaine for subconjunctival anesthesia, which has not been previously studied.

SUBJECTS/METHODS

A prospective, randomised, comparative study involving 196 eyes evaluated the safety and efficacy of subconjunctival anesthesia in phacoemulsification surgery. Pain scores during surgery and one hour post-surgery, surgeon discomfort, postoperative corneal clarity, complications, and additional anesthesia requirement were assessed. Statistical analysis employed descriptive statistics, t-tests, chi-squared tests, and correlations.

RESULTS

Subconjunctival anesthesia significantly lowered pain scores during surgery (p < 0.001) and one hour post-surgery (p < 0.001) compared to topical anesthesia. Surgeon discomfort was notably reduced with subconjunctival anesthesia (p < 0.001). Subconjunctival hemorrhage (p = 0.012) and redness (p = 0.024) were more prevalent postoperatively. No significant difference was observed in intraoperative complications (p = 0.573) or postoperative corneal clarity (p = 0.347).

CONCLUSION

Subconjunctival anesthesia, with the inclusion of 1:100,000 adrenaline in 2% lignocaine, provides effective pain relief and reduces surgeon discomfort during phacoemulsification surgery. The addition of adrenaline extends anesthesia duration. While immediate postoperative effects exist, subconjunctival anesthesia holds promise for enhanced patient comfort and procedural efficiency. Further research is needed to validate its long-term benefits and broader implications in evolving ophthalmic surgical practices.

NCME-Net: Nuclear cataract mask encoder network for intelligent grading using self-supervised learning from anterior segment photographs

Cataracts are a leading cause of blindness worldwide, making accurate diagnosis and effective surgical planning critical. However, grading the severity of the lens nucleus is challenging because deep learning (DL) models pretrained using ImageNet perform poorly when applied directly to medical data due to the limited availability of labeled medical images and high interclass similarity. Self-supervised pretraining offers a solution by circumventing the need for cost-intensive data annotations and bridging domain disparities. In this study, to address the challenges of intelligent grading, we proposed a hybrid model called nuclear cataract mask encoder network (NCME-Net), which utilizes self-supervised pretraining for the four-class analysis of nuclear cataract severity. A total of 792 images of nuclear cataracts were categorized into the training set (533 images), the validation set (139 images), and the test set (100 images). NCME-Net achieved a diagnostic accuracy of 91.0 % on the test set, a 5.0 % improvement over the best-performing DL model (ResNet50). Experimental results demonstrate NCME-Net's ability to distinguish between cataract severities, particularly in scenarios with limited samples, making it a valuable tool for intelligently diagnosing cataracts. In addition, the effect of different self-supervised tasks on the model's ability to capture the intrinsic structure of the data was studied. Findings indicate that image restoration tasks significantly enhance semantic information extraction.

Association of CUL4B with the pathogenesis of age-related cataract

PURPOSE

Age-related cataract (ARC) is the most common cause of visual impairment and blindness in older adults. However, the role of CUL4B in the ARC remains unclear. Therefore, we investigated CUL4B expression and its effects on apoptosis.

MATERIALS AND METHODS

CUL4B expression levels were detected by a quantitative real-time polymerase chain reaction from the anterior lens capsules of patients with ARC and HLE-B3 cells treated with different concentrations of H2O2. CUL4B expression was silenced by siRNA transfection to evaluate apoptosis. CUL4B and apoptotic proteins B cell lymphoma 2 (Bcl-2), myeloid cell leukemia 1 (Mcl-1), caspase-3, cleaved caspase-3, Bax, Bak, and Bid were assessed using western blot analysis. Apoptosis was monitored using the TUNEL assay.

RESULTS

CUL4B expression was downregulated in the anterior lens capsules (P < 0.0001) and H2O2-treated HLE-B3 cells (P = 0.0405). CUL4B protein levels were significantly lower in 100 µmol/L (P = 0.0012) and 200 µmol/L (P = 0.0041) H2O2-treated HLE-B3 cells than in the untreated cells. CUL4B expression was significantly knocked down at the mRNA (P = 0.0043) and protein levels (P = 0.0002) in HLE-B3 cells. Bcl-2 (P = 0.0199), Mcl-1 (P = 0.0042), and caspase-3 (P = 0.0142) were significantly downregulated, whereas cleaved caspase-3 (P = 0.0089) and Bak (P = 0.009) were significantly upregulated in the knockdown group. The TUNEL assay showed a greater induction of apoptosis.

CONCLUSIONS

CUL4B downregulation promotes the apoptosis of lens epithelial cells. Our study may help in understanding the role of CUL4B in ARC pathogenesis.

Impact of lens autofluorescence and opacification on retinal imaging

BACKGROUND

Retinal imaging, including fundus autofluorescence (FAF), strongly depends on the clearness of the optical media. Lens status is crucial since the ageing lens has both light-blocking and autofluorescence (AF) properties that distort image analysis. Here, we report both lens opacification and AF metrics and the effect on automated image quality assessment.

METHODS

227 subjects (range: 19-89 years old) received quantitative AF of the lens (LQAF), Scheimpflug, anterior chamber optical coherence tomography as well as blue/green FAF (BAF/GAF), and infrared (IR) imaging. LQAF values, the Pentacam Nucleus Staging score and the relative lens reflectivity were extracted to estimate lens opacification. Mean opinion scores of FAF and IR image quality were compiled by medical readers. A regression model for predicting image quality was developed using a convolutional neural network (CNN). Correlation analysis was conducted to assess the association of lens scores, with retinal image quality derived from human or CNN annotations.

RESULTS

Retinal image quality was generally high across all imaging modalities (IR (8.25±1.99) >GAF >BAF (6.6±3.13)). CNN image quality prediction was excellent (average mean absolute error (MAE) 0.9). Predictions were comparable to human grading. Overall, LQAF showed the highest correlation with image quality grading criteria for all imaging modalities (eg, Pearson correlation±CI -0.35 (-0.50 to 0.18) for BAF/LQAF). BAF image quality was most vulnerable to an increase in lenticular metrics, while IR (-0.19 (-0.38 to 0.01)) demonstrated the highest resilience.

CONCLUSION

The use of CNN-based retinal image quality assessment achieved excellent results. The study highlights the vulnerability of BAF to lenticular remodelling. These results can aid in the development of cut-off values for clinical studies, ensuring reliable data collection for the monitoring of retinal diseases.

Personalized Lens Correction Improves Quantitative Fundus Autofluorescence Analysis

Purpose

Quantitative fundus autofluorescence (QAF) currently deploys an age-based score to correct for lens opacification. However, in elderly people, lens opacification varies strongly between individuals of similar age, and innate lens autofluorescence is not included in the current correction formula. Our goal was to develop and compare an individualized formula.

Methods

One hundred thirty participants were examined cross-sectionally, and a subset of 30 participants received additional multimodal imaging 2-week post-cataract-surgery. Imaging included the Scheimpflug principle, anterior chamber optical coherence tomography (AC-OCT), lens quantitative autofluorescence (LQAF), and retinal QAF imaging. Among the subset, least absolute shrinkage and selection operator regression and backward selection was implemented to determine which lens score best predicts the QAF value after lens extraction. Subsequently, a spline mixed model was applied to the whole cohort to quantify the influence of LQAF and Scheimpflug on QAF.

Results

Age and LQAF measurements were found to be the most relevant variables, whereas AC-OCT measurements and Scheimpflug were eliminated by backward selection. Both an increase in Scheimpflug and LQAF values were associated with a decrease in QAF. The prediction error of the spline model (mean absolute error [MAE] ± standard deviation) of 32.2 ± 23.4 (QAF a.u.) was markedly lower compared to the current age-based formula MAE of 96.1 ± 93.5. Both smooth terms, LQAF (P < 0.01) and Scheimpflug (P < 0.001), were significant for the spline mixed model.

Conclusions

LQAF imaging proved to be the most predictive for the impact of the natural lens on QAF imaging. The application of lens scores in the clinic could improve the accuracy of QAF imaging interpretation and might allow including aged patients in future QAF studies.

Case report: Whole exome sequencing identified a novel mutation (p.Y301H) of MAF in a Chinese family with congenital cataracts

Background

Congenital cataracts stand as the primary cause of childhood blindness globally, characterized by clouding of the eye's lens at birth or shortly thereafter. Previous investigations have unveiled that a variant in the V-MAF avian musculoaponeurotic-fibrosarcoma oncogene homolog (MAF) gene can result in Ayme-Gripp syndrome and solitary cataract. Notably, MAF mutations have been infrequently reported in recent years.

Methods

In this investigation, we recruited a Chinese family with non-syndromic cataracts. Whole exome sequencing and Sanger sequencing were applied to scrutinize the genetic anomaly within the family.

Results

Through whole exome sequencing and subsequent data filtration, a new mutation (NM_005360, c.901T>C/p.Y301H) in the MAF gene was detected. Sanger sequencing validated the presence of this mutation in another affected individual. The p.Y301H mutation, situated in an evolutionarily preserved locus, was not detected in our 200 local control cohorts and various public databases. Additionally, multiple bioinformatic programs predicted that the mutation was deleterious and disrupted the bindings between MAF and its targets.

Conclusion

Hence, we have documented a new MAF mutation within a Chinese family exhibiting isolated congenital cataracts. Our study has the potential to broaden the spectrum of MAF mutations, offering insights into the mechanisms underlying cataract formation and facilitating genetic counseling and early diagnosis for congenital cataract patients.

A deep network DeepOpacityNet for detection of cataracts from color fundus photographs

BACKGROUND

Cataract diagnosis typically requires in-person evaluation by an ophthalmologist. However, color fundus photography (CFP) is widely performed outside ophthalmology clinics, which could be exploited to increase the accessibility of cataract screening by automated detection.

METHODS

DeepOpacityNet was developed to detect cataracts from CFP and highlight the most relevant CFP features associated with cataracts. We used 17,514 CFPs from 2573 AREDS2 participants curated from the Age-Related Eye Diseases Study 2 (AREDS2) dataset, of which 8681 CFPs were labeled with cataracts. The ground truth labels were transferred from slit-lamp examination of nuclear cataracts and reading center grading of anterior segment photographs for cortical and posterior subcapsular cataracts. DeepOpacityNet was internally validated on an independent test set (20%), compared to three ophthalmologists on a subset of the test set (100 CFPs), externally validated on three datasets obtained from the Singapore Epidemiology of Eye Diseases study (SEED), and visualized to highlight important features.

RESULTS

Internally, DeepOpacityNet achieved a superior accuracy of 0.66 (95% confidence interval (CI): 0.64-0.68) and an area under the curve (AUC) of 0.72 (95% CI: 0.70-0.74), compared to that of other state-of-the-art methods. DeepOpacityNet achieved an accuracy of 0.75, compared to an accuracy of 0.67 for the ophthalmologist with the highest performance. Externally, DeepOpacityNet achieved AUC scores of 0.86, 0.88, and 0.89 on SEED datasets, demonstrating the generalizability of our proposed method. Visualizations show that the visibility of blood vessels could be characteristic of cataract absence while blurred regions could be characteristic of cataract presence.

CONCLUSIONS

DeepOpacityNet could detect cataracts from CFPs in AREDS2 with performance superior to that of ophthalmologists and generate interpretable results. The code and models are available at https://github.com/ncbi/DeepOpacityNet ( https://doi.org/10.5281/zenodo.10127002 ).

Advancements in Cataract Detection: The Systematic Development of LeNet-Convolutional Neural Network Models

Regular screening and timely treatment play a crucial role in addressing the progression and visual impairment caused by cataracts, the leading cause of blindness in Thailand and many other countries. Despite the potential for prevention and successful treatment, patients often delay seeking medical attention due to the gradual and relatively asymptomatic nature of cataracts. To address this challenge, this research focuses on the identification of cataract abnormalities using image processing techniques and machine learning for preliminary assessment. The LeNet-convolutional neural network (LeNet-CNN) model is employed to train a dataset of digital camera images, and its performance is compared to the support vector machine (SVM) model in categorizing cataract abnormalities. The evaluation demonstrates that the LeNet-CNN model achieves impressive results in the testing phase. It attains an accuracy rate of 96%, exhibiting a sensitivity of 95% for detecting positive cases and a specificity of 96% for accurately identifying negative cases. These outcomes surpass the performance of previous studies in this field. This highlights the accuracy and effectiveness of the proposed approach, particularly the superior performance of LeNet-CNN. By utilizing image processing technology and convolutional neural networks, this research provides an effective tool for initial cataract screening. Patients can independently assess their eye health by capturing self-images, facilitating early intervention and medical consultations. The proposed method holds promise in enhancing the preliminary assessment of cataracts, enabling early detection and timely access to appropriate care.

Deep learning for detecting visually impaired cataracts using fundus images

Purpose: To develop a visual function-based deep learning system (DLS) using fundus images to screen for visually impaired cataracts. Materials and methods: A total of 8,395 fundus images (5,245 subjects) with corresponding visual function parameters collected from three clinical centers were used to develop and evaluate a DLS for classifying non-cataracts, mild cataracts, and visually impaired cataracts. Three deep learning algorithms (DenseNet121, Inception V3, and ResNet50) were leveraged to train models to obtain the best one for the system. The performance of the system was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Results: The AUC of the best algorithm (DenseNet121) on the internal test dataset and the two external test datasets were 0.998 (95% CI, 0.996-0.999) to 0.999 (95% CI, 0.998-1.000),0.938 (95% CI, 0.924-0.951) to 0.966 (95% CI, 0.946-0.983) and 0.937 (95% CI, 0.918-0.953) to 0.977 (95% CI, 0.962-0.989), respectively. In the comparison between the system and cataract specialists, better performance was observed in the system for detecting visually impaired cataracts (p < 0.05). Conclusion: Our study shows the potential of a function-focused screening tool to identify visually impaired cataracts from fundus images, enabling timely patient referral to tertiary eye hospitals.

Corneal densitometry: an innovative method to quantitatively evaluate corneal changes after phacovitrectomy

BACKGROUND

To quantitatively investigate corneal changes and the correlation between corneal densitometry (CD) and endothelial parameters after phacovitrectomy.

METHODS

Thirty-eight eyes with idiopathic full-thickness macular holes (iFTMHs) and cataracts underwent phacovitrectomy. Examinations were conducted at baseline and Day 1, Day 7, Month 1, and Month 3 postoperatively. CD and central corneal thickness (CCT) were measured using Pentacam. Corneal endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX) were measured using specular microscopy.

RESULTS

ECD and HEX significantly decreased after surgery and the change in HEX occurred prior to CV. CCT increased immediately after surgery and recovered 3 months postoperatively. CD values increased significantly 1 day after surgery and then gradually decreased. For CD in the 0-2 mm zone, it took 1 month to recover in the central and posterior layers and 3 months in the anterior and total layers. For CD in the 2-6 mm zone, the central layer recovered at Day 7, the anterior and total layers recovered at 1 month, and the posterior layer did not recover until 3 months postoperatively. The CD within all layers in the 0-2 mm zone was positively correlated with CCT. Posterior CD in the 0-2 mm zone was negatively correlated with ECD and HEX.

CONCLUSIONS

CD is not only correlated with CCT, ECD, and HEX but also reflects the state of the whole cornea and each layer. CD can be an objective, rapid, and noninvasive tool that reflects corneal health and undetectable edema and monitors the process of lesion repair.

TRIAL REGISTRATION

This study was registered with the Chinese Clinical Trial Registry (31/10/2021, ChiCTR2100052554).

Prognostic Imaging Biomarkers in Diabetic Macular Edema Eyes Treated with Intravitreal Dexamethasone Implant

BACKGROUND

The aim was to evaluate predictive value of baseline optical coherence tomography (OCT) and OCT angiography (OCTA) parameters in diabetic macular edema (DME) treated with dexamethasone implant (DEXi).

METHODS

OCT and OCTA parameters were collected: central macular thickness (CMT), vitreomacular abnormalities (VMIAs), intraretinal and subretinal fluid (mixed DME pattern), hyper-reflective foci (HRF), microaneurysms (MAs) reflectivity, ellipsoid zone disruption, suspended scattering particles in motion (SSPiM), perfusion density (PD), vessel length density, and foveal avascular zone. Responders' (RES) and non-responders' (n-RES) eyes were classified considering morphological (CMT reduction ≥ 10%) and functional (BCVA change ≥ 5 ETDRS letters) changes after DEXi. Binary logistic regression OCT, OCTA, and OCT/OCTA-based models were developed.

RESULTS

Thirty-four DME eyes were enrolled (18 treatment-naïve). OCT-based model combining DME mixed pattern + MAs + HRF and OCTA-based model combining SSPiM and PD showed the best performance to correctly classify the morphological RES eyes. In the treatment-naïve eyes, VMIAs were included with a perfect fit for n-RES eyes.

CONCLUSION

The presence of DME mixed pattern, a high number of parafoveal HRF, hyper-reflective MAs, SSPiM in the outer nuclear layers, and high PD represent baseline predictive biomarkers for DEXi treatment responsiveness. The application of these models to treatment-naïve patients allowed a good identification of n-RES eyes.

Cataracts

94 million people are blind or visually impaired globally, and cataract is the most common cause of blindness worldwide. However, most cases of blindness are avoidable. Cataract is associated with decreased quality of life and reduced life expectancy. Most cases of cataract occur after birth and share ageing and oxidative stress as primary causes, although several non-modifiable and modifiable risk factors can accelerate cataract formation. In most patients, phacoemulsification with intraocular lens implantation is the preferred treatment and is highly cost-effective. There has been an increase in the use of comprehensive cataract surgical services, including diagnoses, treatment referrals, and rehabilitation. However, global inequity in surgical service quality is still a limitation. Implementation of preoperative risk assessment, risk reduction strategies, and new surgical technologies have made cataract surgery possible at an earlier stage of cataract severity with the expectation of good refractive outcomes. The main challenge is making the service that is currently available to some patients accessible to all by use of universal health coverage.

Vision-specific and cancer-specific quality of life in ocular graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

PURPOSE

To compare the vision-specific and cancer-specific quality of life (QOL) between patients with and without ocular graft-versus-host disease (oGVHD) after allogeneic hematopoietic stem cell transplantation (alloHCT).

METHODS

This cross-sectional observational study analyzed 142 patients after alloHCT including 94 patients with oGVHD and 48 without. oGVHD was diagnosed according to International Chronic Ocular GVHD Consensus Group (ICOGCG) criteria. QOL was assessed by using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30).

RESULTS

Compared with non-oGVHD patients, patients with oGVHD had worse vision-specific (NEI VFQ-25: 64.3 ± 20.3 vs. 77.6 ± 19.3, P < 0.001) and cancer-specific (EORTC QLQ-C30: 59.9 ± 20.3 vs. 67.4 ± 17.5, P = 0.03) QOL, as well as impaired cognitive function (72.7 ± 22.1 vs. 82.3 ± 19.0, P = 0.01). The vision-specific QOL was significantly correlated with ICOGCG score (β =  - 1.88, 95%CI: - 3.35 to - 0.41, P = 0.01) and post-alloHCT medical expense (β =  - 5.70, 95%CI: - 10.35 to - 1.05, P = 0.02), while cancer-specific QOL was strikingly correlated with post-alloHCT medical expense (β =  - 9.91, 95%CI: - 14.43 to - 5.39, P < 0.001), frequency of ophthalmic medication (β =  - 0.93, 95%CI: - 1.64 to - 0.21, P = 0.01), education (β =  - 6.97, 95%CI: - 13.31 to - 0.62, P = 0.03), and peripheral blood stem cell use (β =  - 6.42, 95%CI: - 12.59 to - 0.25, P = 0.04).

CONCLUSIONS

Patients with oGVHD experienced significant impairment in both vision-specific and cancer-specific QOL including cognitive function when compared with those without after alloHCT. Multidimensional QOL assessment should be included in the long-term alloHCT survivorship care.

Intraocular scatter compensation with spatial light amplitude modulation for improved vision in simulated cataractous eyes

Cataract is one of the common causes of visual impairment due to opacification of the crystalline lens. Increased intraocular scattering affects the vision of cataract patients by reducing the quality of the retinal image. In this study, an amplitude modulation-based scatter compensation (AM-SC) method is developed to minimize the impact of straylight on the retinal image. The performance of the AM-SC method was quantified by numerical simulations of point spread function and retinal images in the presence of different amounts of straylight. The approach was also experimentally realized in a single-pass system with a digital micro-mirror device used as a spatial amplitude modulator. We showed that the AM-SC method allows to enhance contrast sensitivity in the human eyes in vivo with induced scattering.

Correlation Between Degree of Lens Opacity and the Phacoemulsification Energy Parameters Using Different Imaging Methods in Age-Related Cataract

Purpose

To compare the correlation between degree of lens opacity and the phacoemulsification energy parameter in patients with age-related cataract as determined by slit lamp, 25-MHz ultrasound biomicroscopy (UBM), and Scheimpflug imaging (Pentacam) and to evaluate the application of these three methods to measuring lens opacification.

Methods

This observational study was conducted in 319 patients (381 eyes) with different types of age-related cataract. The average age of patients was 67.3 ± 11.4 years. The degree of lens opacity acquired by slit lamp, 25-MHz UBM, and Pentacam was determined by the Lens Opacity Classification System III (LOCSIII), pixel units calculated by ImageJ, and lens density, respectively. We primarily analyzed and compared the correlation between lens opacity and the cumulative dissipated energy (CDE) values of phacoemulsification.

Results

Cortical, nuclear, and posterior subcapsular (PSC) cataracts were evaluated as follows: LOCSIII grades 3.31 ± 1.42, 3.29 ± 1.49, and 0.91 ± 0.83; pixel units 120.91 ± 22.8, 93.2 ± 15.9, and 99.7 ± 13.0; and lens density 51.8 ± 31.2, 21.2 ± 6.10, and 53.3 ± 35.3, respectively. The CDE values were 12.1 ± 12.4, 13.5 ± 9.11, and 3.93 ± 1.96. In cortical cataract, there was a linear correlation among LOCSIII, pixel units, and CDE value (r = 0.560, r = 0.832, and r = 0.582, respectively; both P < 0.05), but lens density had no correlation with other parameters. In nuclear cataract, there was a linear correlation among LOCSIII, lens density, and CDE value (r = 0.747, r = 0.865, and r = 0.906, respectively; both P < 0.05), but pixel units had no correlation with other parameters. In PSC, only pixel units and LOCSIII showed a correlation.

Conclusions

The various imaging methods offered different advantages in terms of determining lens opacity, a feature related to types of age-related cataracts. Choosing the most suitable imaging method to evaluate lens opacification based on the type of age-related cataract is important for accurately predicting the phacoemulsification parameters for cataract surgery.

Translational Relevance

Determining the appropriate phacoemulsification strategy depends on quantitative analysis of the degree of lens opacity to reduce intraoperative and postoperative complications and to obtain the optimal postoperative visual outcome.

Clinical Practice of Cataract Special Care Standards in Nonophthalmic Wards

Cataract is a lens metabolism disease, which is caused by various factors, and leads to metamorphic lens proteins turbidity. Cataract commonly occurs in elderly patients, and majority of these patients have clinical manifestations of blurred vision and other symptoms. In this study, we explored the clinical practice and observations of cataract care criteria in nonophthalmic wards. To realize this, a total of one hundred and twenty (120) cataract patients, admitted to the East Department of Ophthalmology, Shanghai Sixth People's Hospital, particularly from April 2019-2020, were divided into the control and observation groups, where 60 cases were added to each group. The control group received routine nursing, and observation group was treated with cataract care criteria based on the control group. The complication rate, health cognition, and patient's satisfaction were compared with existing approaches. The incidence of corneal edema, anterior chamber hemorrhage, endophthalmitis, and incision infection, specifically in the observation group, was lower than that in the control group (P < 0.05). Likewise, the number of hospitalization days and expenses, specifically in the observation group, were lower than those in the control group (P < 0.05). Health knowledge and satisfaction scores of the observation group were higher than the control group (P < 0.05). Active service, service attitude, psychological support, caring patients, and health education dissatisfaction rate of the observation group were lower than the control group (P < 0.05). Finally, the standard of cataract care in nonophthalmic wards reduces the incidence of complications, improve health awareness of patients, and help to improve satisfaction of patients with nurses. Furthermore, it is worthy of promotion and application particularly in traditional hospitals.

Swept Source Optical Coherence Tomography Analysis of a Selected Eye's Anterior Segment Parameters in Patients with Pseudoexfoliation Syndrome

Background: Pseudoexfoliation syndrome (PEX) is a systemic, age-related disorder characterized by the production and accumulation of pseudoexfoliation material. To date, detailed characteristics have not been published regarding the iridocorneal angle and cornea in patients with pseudoexfoliation syndrome determined through swept source optical coherence tomography (SS-OCT). Methods: A total of 150 eyes of patients with pseudoexfoliation syndrome (ages 69–86 years) and 166 eyes in a control group (ages 54–79 years) were analyzed. Results: The central corneal thickness in the PEX group was 549.56 μm and was slightly (insignificantly) higher than that of the control group (540.56 µm). The anterior chamber of the eye was visibly shallower in patients with PEX syndrome than in those of the control group (2.49 mm vs. 3.07 mm; p < 0.001). The Fourier analysis parameters of the cornea showed multiple differences between the PEX and control groups. With respect to iris area, the parameters showed statistically significant differences between the PEX and control groups in all four quadrants of the eye. No statistical significance was found in the PEX group for the iridocorneal angle parameters, or corneal and lens parameters depending on gender and age. Conclusions: PEX syndrome is characterized by a significant impact on the anterior eye segment, including higher anterior and posterior keratometric values, lower anterior chamber depth, higher iris thickness, and narrower angle parameters. The characteristic anterior eye segment features of PEX syndrome can be detected using SS-OCT, which could potentially assist clinicians in properly managing the disease.

Deep Learning Automated Diagnosis and Quantitative Classification of Cataract Type and Severity

PURPOSE

To develop and evaluate deep learning models to perform automated diagnosis and quantitative classification of age-related cataract, including all three anatomical types, from anterior segment photographs.

DESIGN

Application of deep learning models to Age-Related Eye Disease Study (AREDS) dataset.

PARTICIPANTS

18,999 photographs (6,333 triplets) from longitudinal follow-up of 1,137 eyes (576 AREDS participants).

METHODS

Deep learning models were trained to detect and quantify nuclear cataract (NS; scale 0.9-7.1) from 45-degree slit-lamp photographs and cortical (CLO; scale 0-100%) and posterior subcapsular (PSC; scale 0-100%) cataract from retroillumination photographs. Model performance was compared with that of 14 ophthalmologists and 24 medical students. The ground truth labels were from reading center grading.

MAIN OUTCOME MEASURES

Mean squared error (MSE).

RESULTS

On the full test set, mean MSE values for the deep learning models were: 0.23 (SD 0.01) for NS, 13.1 (SD 1.6) for CLO, and 16.6 (SD 2.4) for PSC. On a subset of the test set (substantially enriched for positive cases of CLO and PSC), for NS, mean MSE for the models was 0.23 (SD 0.02), compared to 0.98 (SD 0.23; p=0.000001) for the ophthalmologists, and 1.24 (SD 0.33; p=0.000005) for the medical students. For CLO, mean MSE values were 53.5 (SD 14.8), compared to 134.9 (SD 89.9; p=0.003) and 422.0 (SD 944.4; p=0.0007), respectively. For PSC, mean MSE values were 171.9 (SD 38.9), compared to 176.8 (SD 98.0; p=0.67) and 395.2 (SD 632.5; p=0.18), respectively. In external validation on the Singapore Malay Eye Study (sampled to reflect the distribution of cataract severity in AREDS), MSE was 1.27 for NS and 25.5 for PSC.

CONCLUSIONS

A deep learning framework was able to perform automated and quantitative classification of cataract severity for all three types of age-related cataract. For the two most common types (NS and CLO), the accuracy was significantly superior to that of ophthalmologists; for the least common type (PSC), the accuracy was similar. The framework may have wide potential applications in both clinical and research domains. In the future, such approaches may increase the accessibility of cataract assessment globally. The code and models are publicly available at https://XXX.

Comparison of the IOLMaster 700 and the Pentacam in the Analysis of the Lens Nuclear Density Before the Cataract Surgery

Purpose: To evaluate the difference of the lens nuclear density measured before and after mydriasis by using the IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany) and the Pentacam Scheimpflug imaging (Pentacam HR, Oculus Incorporation, Wetzlar, Germany) and investigate the relationship between the measurement data and the phacoemulsification parameters.

Methods: Patients with age-related nuclear cataracts diagnosed on the slit-lamp examination were enrolled in the age range of 53–76 years. No patient had a history of ocular surgery, laser treatment, or general disorders affecting vision. The mean optical density (OD) was measured by the IOLMaster 700 by using the Image-Pro^® Plus software before and after mydriasis. The Pentacam nucleus densitometry (PND) was obtained automatically from the Pentacam Scheimpflug imaging and compared with OD. The correlation between OD and effective phacoemulsification time (EPT), PND, and EPT were analyzed, respectively.

Results: In this study, 53 eyes of 52 patients were evaluated. Before and after mydriasis, the mean OD values were 64.34 ± 23.31 and 63.81 ± 23.21 pixel units, respectively; the mean PND values were 28.51 ± 11.42 and 25.41 ± 11.31, respectively; and the mean EPT value was 6.24 ± 3.49. The Bland–Altman analysis showed that the lens nuclear densities of the two devices were highly consistent. There was no significant difference in the OD values (t = 0.455, p > 0.05) before and after mydriasis, but the difference has existed in the PND values (t = 2.509, p < 0.05). The OD and PND values were positively correlated with EPT before and after mydriasis (r_OD−Before = 0.604, r_OD−After = 0.593, r_PND−Before = 0.701, and r_PND−After = 0.891, p < 0.01).

Conclusion: The combination of the IOLMaster 700 and the Image-Pro^® Plus software can quantitatively evaluate the degree of the cataract lens opacification. It has good consistency with the Pentacam and is positively correlated with the phacoemulsification parameters. It is expected to become a new method to predict the phacoemulsification parameters before and during cataract surgery.

Investigation of the scattering and attenuation properties of cataracts formed in mouse eyes with 1060-nm and 1310-nm swept-source optical coherence tomography

Cataracts are the leading cause of blindness worldwide. Here we propose optical coherence tomography (OCT) as a quantitative method for investigating cataracts. OCT provides volumetric and non-invasive access to the lens and makes it possible to rapidly observe the formation of opacifications in animal models such as mice. We compared the performance of two different wavelengths - 1060 nm and 1310 nm - for OCT imaging in cataract research. In addition, we present multi-contrast OCT capable of mapping depth-resolved scattering and average anterior cortical attenuation properties of the crystalline lens and quantitatively characterize induced cataract development in the mouse eye. Lastly, we also propose a novel method based on the retinal OCT projection image for quantifying and mapping opacifications in the lens, which showed a good correlation with scattering and attenuation characteristics simultaneously analyzed during the process of cataract formation in the lens.

Imaging Biomarkers of 1-Year Activity in Type 1 Macular Neovascularization

Purpose

The purpose of this study was to evaluate the predictive value of optical coherence tomography (OCT) and OCT angiography (OCTA) parameters at baseline on lesion's activity at the 1-year follow-up in type 1 macular neovascularizations (MNVs) treated with 1-year fixed regimen of intravitreal aflibercept injections (q8 IAIs).

Methods

All patients were imaged by structural OCT to evaluate central macular thickness (CMT), subretinal fluid (SRF), subretinal hyper-reflective material (SHRM), intraretinal fluid (IRF) and intraretinal hyper-reflective dots (HRDs), and by Swept-Source OCTA to measure baseline MNV area, perfusion density (PD), vessel length density (VLD), and vessel diameter index. At the end of q8 IAI, patients were classified in two groups: active-MNV (A-MNV) and inactive-MNV (I-MNV), considering the OCT signs of activity. Three binary logistic regression models were developed: (1) OCT-based, (2) OCTA-based, and (3) OCT/OCTA-based model.

Results

Thirty-one treatment-naïve type 1 MNVs were enrolled (13 A-MNV and 18 I-MNV). No differences were observed in baseline OCT and OCTA characteristics between A-MNV and I-MNV. Among the models developed, model 3 that combined OCT/OCTA parameters showed a performance of 87.5% and excellent sensitivity for A-MNV lesions (100%). By analyzing the model, the A-MNV group appears more likely to show at baseline SRF, greater CMT, wider MNV area, and lower PD and VLD compared to I-MNV.

Conclusions

Our study demonstrated that the combination of baseline OCT and OCTA parameters allowed to achieve a good models’ performance in the prediction of MNV activity permitting to correctly classifying the active lesions at the end of follow-up period, with excellent sensitivity.

Translational Relevance

OCT/OCTA could integrate statistical models potentially useful for artificial intelligence.

Intralenticular changes in eyes with mature senile cataract on modified posterior segment optical coherence tomography

Purpose

To study the morphological changes within mature senile cataracts on modified posterior segment optical coherence tomography (OCT).

Methods

A cross-sectional observational study recruiting patients of mature cataracts admitted for elective cataract surgery in tertiary eye care. A modified OCT imaging of the lens was done and lenticular findings were noted by a single observer. Corresponding slit-lamp biomicroscopic findings and intraoperative experiences were also noted by a second observer and respective surgeons.

Results

Forty-four eyes of 44 patients were included. The mean age of patients was 65 ± 5.7 years. The intralenticular findings were uniform in groups of eyes, and they were characterized into three stages. First was a stage of early lamellar separation where small intralenticular clefts were noted superficially. Second was the stage of established lamellar separation where crescentic fluid clefts appeared interspersed between the lens fibers, and the depth increased as a function of severity. Both these stages did not show any distinct slit-lamp or intraoperative findings. A third stage of liquefaction identified as extensive lamellar separation with subcapsular fluid pockets. This was also reflected in slit-lamp biomicroscopy, showing the hydrated cortex with intraoperative challenges. Two cases showed peculiar changes, one of a hyperreflective subcapsular sheath and another of superficial nuclear lamellar separation.

Conclusion

Mature cataracts may also show graded progression, which could be delineated on lenticular OCT. This could be of immense help in pre-operative planning and optimal management of these high-risk cases.

Swept Source Optical Coherence Tomography Analysis of the Selected Eye's Anterior Segment Parameters

BACKGROUND

The present study determined the mean reference values of the anterior segment parameters of the selected eye using swept source optical coherence tomography (SS-OCT) in healthy Caucasian participants.

METHODS

A total of 166 volunteers (age 54-79 years), women (n = 92) and men (n = 74), were analyzed. One eye of each subject was randomly selected for anterior segment imaging. The anterior segment of the eye was scanned with CASIA2. The analyzed anterior segment parameters were divided into three groups, namely parameters of the cornea, lens, and angle.

RESULTS

The OCT (e.g., Ks, Kf, pKf, pKs, and central corneal thickness) and Fourier parameters of the cornea were significantly different between females and males. The iridocorneal angle was the smallest in the upper quadrant for all distance from the apex of the angle (250, 500, and 750 µm).

CONCLUSIONS

Therefore, SS-OCT enables the analysis of parameters of the cornea, anterior chamber, lens, and iridocorneal angle, highlighting its clinical utility. Sex-specific differences in the analyzed parameters should be taken into account during the diagnosis of corneal diseases. The configuration of the filtration angle is an important marker during glaucoma diagnosis and drainage implant surgery. Measurements with CASIA 2is characterized by very good repeatability.

Corneal Analysis with Swept Source Optical Coherence Tomography in Patients with Coexisting Cataract and Fuchs Endothelial Corneal Dystrophy

This study focused on defining the characteristic features of keratometry and pachymetry elevation maps based on swept source optical coherence tomography (SS OCT) in Fuchs endothelial corneal dystrophy (FECD) eyes with a coexisting cataract. 70 eyes of 35 patients diagnosed with FECD and a coexisting cataract and 70 control eyes were included in this prospective, controlled, observational, cross-sectional study. Features characteristic of intermediately affected eyes included an increased corneal thinnest thickness (CTT) (p = 0.01), 3 and 6 mm asymmetry (p < 0.0001), higher order Fourier indices (p < 0.05 and p ≤ 0.0001, respectively), chord µ, and a posterior Ectasia Screening Index (pESI) (p < 0.01). The lack of agreement between the anterior and posterior elevation map and a significant area of negative values in the posterior map were detected. In advanced FECD eyes, our study additionally revealed decreased posterior keratometry steep (Ks), keratometry flat (Kf), keratometry average (AvgK), eccentricity (Ecc), an increased corneal apex thickness (CAT), and decreased 3 and 6 mm posterior spherical indices (p < 0.0001 for all of the above). Characteristic features of subclinical FECD, independent of the corneal thickness, can be detected by SS OCT and should be considered during the preoperative assessment of patients with a coexisting cataract.

FACTORS ASSOCIATED WITH PREVALENT LENS OPACITIES IN CHINESE AMERICAN ADULTS: THE CHINESE AMERICAN EYE STUDY

PURPOSE

To identify risk factors associated with lens opacities in Chinese Americans.

METHODS

A cross-sectional population-based study of 4,582 Chinese Americans ≥50 years residing in Monterey Park, California. Participants completed a comprehensive clinical examination with lens assessment using the Lens Opacities Classification System II, with lens opacities defined by a grade ≥2 in either eye. Participants were considered to have nuclear-only, cortical-only, or posterior subcapsular (PSC)-only if that was the only type of opacity present in both eyes.

RESULTS

Cortical-only opacity was associated with older age, diabetes mellitus (OR 1.5, 95%CI 1.1-2.1), and family history of cataracts (OR 1.5, 95%CI 1.2-1.9). Nuclear-only opacity was associated with older age, diabetes mellitus (OR 1.4, 95%CI 1.1-1.9), greater waist-to-hip ratio (OR 1.2, 95%CI 1.1-1.4), and high-density lipoprotein (OR 1.1, 95%CI 1.02-1.2). Mixed-type opacities were associated with older age, greater waist-to-hip ratio (OR 1.3, 95%CI 1.1-1.6), and higher HbA1 c (OR 1.3, 95%CI 1.1-1.4). Taller height (OR 0.7, 95%CI 0.6-0.8), greater weight (OR 0.98, 95%CI 0.97-0.99), and higher diastolic pressure (OR 0.98, 95%CI 0.96-0.99) were protective.

CONCLUSION

CHES identified a strong, dose-response association between age and all types of prevalent lens opacities, which suggests an increasing cataract burden in Chinese Americans based on aging populations. CHES results demonstrate general consistency with previous population-based studies in regard to more sedentary lifestyle exposures (e.g., Westernized lifestyle) and prevalent cortical-only, nuclear-only, and mixed-type opacities, yet also identified further sedentary lifestyle exposures associated with prevalent lens opacities. Improved glycemic control and a more active lifestyle that minimizes factors contributing to metabolic syndrome may help reduce the burden of vision loss associated with lens opacities.

Serum Aβ Levels are Associated with Age-related Cataract

To investigate the levels and clinical relevance of serum β-amyloid (Aβ) in age-related cataract (ARC) patients. In the present study, an overall of 402 ARC patients and 450 normal controls were recruited between June 2018 and December 2019. Serum Aβ1-40 and Aβ1-42 concentrations were assessed by Elisa. The ARC patients were further grouped into several subgroups according to gender, age, types of ARC, and degree of lens opacity. The association of Aβ levels with ARC was determined using logistic regression models. ARC patients had significantly higher serum Aβ1-40 and Aβ1-42 levels than normal control. A similar finding was observed in subjects aged over 60 years. Serum Aβ concentrations were significant correlated with the degrees of lens opacity in C-ARC and N-ARC subjects. Logistic regression analyses revealed that serum Aβ1-40 (ORs = 1.202, 95% CI 1.077 to 1.341) and Aβ1-42 (ORs = 1.686, 95% CI 1.351 to 2.103) levels were potential risk factors for ARC. ARC patients have higher serum Aβ1-40, as well as Aβ1-42 levels, which may reflect an association between Aβ and ARC pathogenesis. Serum Aβ1-42 and Aβ1-40 levels are potential risk factors for ARC.

Human cataractous lenses contain cross-links produced by crystallin-derived tryptophanyl and tyrosyl radicals

Protein insolubilization, cross-linking and aggregation are considered critical to the development of lens opacity in cataract. However, the information about the presence of cross-links other than disulfides in cataractous lenses is limited. A potential role for cross-links produced from tryptophanyl radicals in cataract development is suggested by the abundance of the UV light-sensitive Trp residues in crystallin proteins. Here we developed a LC-MS/MS approach to examine the presence of Trp-Trp, Trp-Tyr and Tyr-Tyr cross-links and of peptides containing Trp-2H (-2.0156 Da) in the lens of three patients diagnosed with advanced nuclear cataract. In the proteins of two of the lenses, we characterized intermolecular cross-links between βB2-Tyr¹⁵³-Tyr¹⁰⁴-βA3 and βB2-Trp¹⁵⁰-Tyr¹³⁹-βS. An additional intermolecular cross-link (βB2-Tyr⁶¹-Trp²⁰⁰-βB3) was present in the lens of the oldest patient. In the proteins of all three lenses, we characterized two intramolecular Trp-Trp cross-links (Trp¹²³-Trp¹²⁶ in βB1 and Trp⁸¹-Trp⁸⁴ in βB2) and six peptides containing Trp -2H residues, which indicate the presence of additional Trp-Trp cross-links. Relevantly, we showed that similar cross-links and peptides with modified Trp-2H residues are produced in a time-dependent manner in bovine β-crystallin irradiated with a solar simulator. Therefore, different crystallin proteins cross-linked by crystalline-derived tryptophanyl and tyrosyl radicals are present in advanced nuclear cataract lenses and similar protein modifications can be promoted by solar irradiation even in the absence of photosensitizers. Overall, the results indicate that a role for Trp-Tyr and Trp-Trp cross-links in the development of human cataract is possible and deserves further investigation.

A Simple Pre-Operative Nuclear Classification Score (SPONCS) for Grading Cataract Hardness in Clinical Studies

Background: The aim of this study was to evaluate whether a simplified pre-operative nuclear classification score (SPONCS) was valid, both for clinical trials and real-world settings. Methods: Cataract classification was based on posterior nuclear color: 0 (clear), 1 (subcapsular/posterior cataract with clear nucleus), 2 (mild “green nucleus” with plus sign for yellow reflection of the posterior cortex), 3 (medium “yellow nucleus” with plus sign for brown/red posterior cortex reflection), 4 (advanced with 4 being “red/brown nucleus” and 4+ white nucleus), and 5 (hypermature/Morgagnian nucleus). Inter- and intra-observer validity was assessed by 30 Ophthalmologists for 15 cataract cases. The reliability of the cataract grading score in a surgical setting was evaluated. Correlation of nuclear scores was compared with phacoemulsification cumulative dissipated energy (CDE) in 596 patients. Results: Analysis of mean intra-observer Cohen kappa agreement was 0.55 with an inter-observer score of 0.54 for the first assessment and 0.49 for the repeat assessment one week later. When evaluating results by nuclear color alone, there was a substantial agreement for both the intra-observer (0.70) and inter-observer parameters: 0.70 for the first test, and 0.66 on repetition with randomization of the cases after a week. CDE levels were found to be significantly different between all SPONCS score groups (p < 0.001), with a lower CDE related to a lower SPONCS score. A strong correlation was found between the SPONCS score and CDE (Spearman′s rho = 0.8, p < 0.001). Conclusion: This method of grading cataract hardness is both simple and repeatable. This system can be easily incorporated in randomized controlled trials to lower bias and confounding effects regarding nuclear density along with application in the clinical setting.

Analysis of lens epithelium telomere length in age-related cataract

We aimed to investigate the associations among lens epithelium telomere length (LETL), cataract types, and systemic pro-senescence factors in patients with age-related cataract. In this prospective study, the general demographic factors, body mass index, smoking history, depression, hypertension, diabetes, various psychological measures, and uncorrected distant visual acuity of patients with age-related cataract were recorded. Lens Opacities Classification System III (LOCS III) scores and lens density measured by Scheimpflug imaging were used to evaluate the cataracts. LETL was measured by real-time polymerase chain reaction. Correlations among these parameters were analyzed. The LOCS III nuclear opalescence (NO) score was associated with age (β = 0.053, P < 0.001) and Patient Health Questionnaire-9 score (β = -0.042, P = 0.004). Smoking was identified as a risk factor affecting LOCS III NO score (odds ratio = 1.546, 95% confidence interval, 1.128-2.119), but not the LOCS III cortical or posterior subcapsular scores. LETLs showed a weak association with systemic factors and LOCS III scores, and a significantly moderate correlation with the average objective lens densities of different regions measured by Scheimpflug imaging (r values ranged from -0.278 to -0.523, P < 0.05). However, there was no correlation between the LETLs and the maximum lens densities. The groups with a relatively low lens density had longer LETLs. In Conclusion, being an age-related disease, cortical cataract was also associated with "aging of the lens epithelium." Notably, lens epithelium activity rarely showed systemic effects. Thus, future studies should emphasize the importance of the telomeric system in cataractous process and aging.

Ophthalmic image acquired by ophthalmologists and by allied health personnel as part of a telemedicine strategy: a comparative study of image quality

OBJECTIVES

This study evaluates the quality of ophthalmic images acquired by a nurse technician trained in teleophthalmology as compared with images acquired by an ophthalmologist, in order to provide a better understanding of the workforce necessary to operate remote care programs.

METHODS

A cross-sectional study was performed on 2044 images obtained from 118 participants of the TeleOftalmo project, in Brazil. Fundus and slit-lamp photography were performed on site by an ophthalmologist and by a nurse technician under the supervision of a remote ophthalmologist. Image quality was then evaluated by masked ophthalmologists. Proportion of suitable images in each group was compared.

RESULTS

The proportion of concordant classification regarding quality was 94.8%, with a corrected kappa agreement of 0.94. When analyzing each type of photo separately, there was no significant difference in the proportion of suitable images between on-site ophthalmologist and nurse technician with remote ophthalmologist assistance for the following: slit-lamp views of the anterior segment and anterior chamber periphery, and fundus photographs centered on the macula and on the optic disc (P = 0.825, P = 0.997, P = 0.194, and P = 0.449, respectively). For slit-lamp views of the lens, the proportion of suitable images was higher among those obtained by an ophthalmologist (99.6%) than by a technician (93.8%, P < 0.01).

CONCLUSIONS

Ophthalmic photographs acquired by a trained technician consistently achieved >90% adequacy for remote reading. Compared with ophthalmologist-acquired photos, the proportion of images deemed suitable achieved a high overall agreement. These findings provide favorable evidence of the adequacy of teleophthalmological imaging by nurse technicians.

Correlation among Lens Opacities Classification System III grading, the 25-item National Eye Institute Visual Functioning Questionnaire, and Visual Function Index-14 for age-related cataract assessment

Purpose

To evaluate the relationship between cataract types and subjective visual function among patients with age-related cataract.

Methods

This was a prospective, multicenter, 831 Chinese patient-based, cross-sectional study. Patients were administered the Visual Function Index-14 (VF-14) and the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) to evaluate their subjective visual function. Lens Opacities Classification System III (LOCS III) was used to evaluate the type of cataract. Relationships among these parameters were analyzed.

Results

LOCS III cortical (C) and posterior subcapsular scores are negatively associated with VF-14 (r = − 0.188, P < 0.01; r = − 0.146, P < 0.01) and total score of NEI-VFQ-25 (r = − 0.223, P < 0.01; r = − 0.160, P < 0.01), respectively; LOCS III nuclear opalescence (NO) score is positively associated with VF-14 (r = 0.087, P < 0.05) and total score of NEI-VFQ-25 (r = 0.097, P < 0.05). In multiple linear regression, a decrease in the LOCS III C score is a significant predictor for improvement of the total score of NEI-VFQ-25 (β = − 1.286, P < 0.05). In contrast, an increase in LOCS III NO score is a significant predictor for improvement of VF-14 (β = 3.826, P < 0.01) and total score of NEI-VFQ-25 (β = 4.618, P < 0.01). Patients with LOCS III C score ≤ 2 have higher VF-14 (49.38 versus 43.74, P < 0.01), total (80.73 versus 71.58, P < 0.01) and subscale scores of NEI-VFQ-25 than patients with LOCS III C score > 2.

Conclusion

Cortical cataract has adverse effects on subjective visual function, while mild-to-moderate nuclear cataract has positive effects. Furthermore, “LOCS III C score > 2” can be a potential cutoff as a reference for cataract surgery without self-assessing questionnaires.

Electronic supplementary material

The online version of this article (10.1007/s10792-020-01353-0) contains supplementary material, which is available to authorized users.

Prevalence and risk factors on age-related cataract and surgery in adults over 50 years old in Binhu District, Wuxi, China

AIM

To investigate the prevalence and risk factors of age-related cataract (ARC), ARC surgery procedures, and postoperative vision results among adults over 50 years old in the Binhu District of Wuxi City, China.

METHODS

Thirty basic sampling units were analyzed via a cluster random sampling method. Detailed medical histories were collected and eye examinations were performed. Cataract prevalence and surgical procedures were quantified.

RESULTS

Among the 6150 participants, 1421 cataract cases were diagnosed and prevalence was 23.1%. The prevalence of cortical, nuclear, and posterior subcapsular cataracts increased with age (P<0.001). Cataract prevalence was significantly higher among elderly, female, or illiterate individuals and people with hypertension, diabetes, and a history of smoking and drinking (all P<0.05). As participant age increased and education level decreased, the frequency of cataract blindness surgeries gradually decreased, but without statistical significance within groups (P>0.05). The odds ratio of cataract patients who had or did not have cataract surgery was 3.15 (87/28) and the frequency of cataract blindness surgery was 75.7% (87/115). Poor visual outcomes was in 107 eyes (40.7%) after cataract surgery. Poor vision was mostly caused by uncorrected reflective errors (30.9%) and ocular comorbidities (41.1%). The prevalence of cataract surgery complications was 5.7% (15/263). Surgical complications and posterior capsular opacification were avoidable factors facilitating poor vision.

CONCLUSION

ARC, especially in females and illiterate individuals, presents a public health problem in this district. Poor visual outcomes after cataract surgery are frequent. High-quality cataract surgeries and treatment of ocular comorbidities are vital.

Appearance of cysts and capillary non perfusion areas in diabetic macular edema using two different OCTA devices

The aim of this paper was to distinguish the appearance of cysts and non-perfusion areas (NPAs) in diabetic macular edema (DME) using two different Optical Coherence Tomography Angiography (OCTA) devices. In this study, patients underwent OCTA using the AngioVue XR Avanti Spectral Domain (SD) OCTA and the PLEX Elite 9000 Swept-Source (SS) OCTA. Foveal and extrafoveal regions of interest (ROI), defined as any area with an altered flow signal comparing to the surrounding retina, were selected in superficial and deep capillary plexus (SCP and DCP). ROI reflectivity were classified as hypo-reflective or hyper-reflective. Foveal ROI were analyzed to detect suspended scattering particles in motion (SSPiM). Thirty-seven DME eyes were included. A larger number of ROIs were found in SCP (55 vs 39) and DCP (60 vs 49) using PLEX Elite 9000 vs AngioVue. The majority of ROIs were hypo-reflective with both instruments, while slightly more hyper-reflective ROIs (grey) were detected with the PLEX Elite, more likely to be cysts. The hyporeflective ROIs could be NPAs or cysts with both devices. Moreover, PLEX Elite 9000 identified SSPiM in more foveal ROIs than the AngioVue in the SCP (p = 0.005) and in the DCP (p = 0.027). In conclusion, NPAs and cysts may show variable appearances using different OCTA devices. Hyperreflective ROIs generally correspond to cysts, hyporeflective ROIs can be either cysts or NPAs. The SS-OCTA seems to detect SSPiM more frequently than the SD-OCTA.

The Lens Opacities Classification System III Grading in Irradiated Uveal Melanomas to Characterize Proton Therapy-Induced Cataracts

PURPOSE

To evaluate the use of the Lens Opacities Classification System III grading (LOCS III) for the characterization of radiation-induced cataract, and to correlate the proton beam projection onto the lens with cataract location and grade as defined by the LOCS III.

DESIGN

Prospective, interventional case series.

METHODS

Fifty-two consecutive patients with cataract following proton therapy were included. All cataracts were graded using LOCS III. Relationships between proton beam and cataract subtypes, as well as between dose, proportion of lens irradiated, and extent of cataracts, were assessed.

RESULTS

Tumor diameter, volume, stage, and equatorial tumor location were associated with extent of posterior subcapsular cataracts (PSC) that were diagnosed at a median (interquartile range) 36 months (22;83) after treatment. In multivariate analysis, the tumor volume (P < .01) and an equatorial tumor location (P = .01) were risk factors for extensive PSC. Lens irradiation was avoided in 10 patients. In the remaining 42 patients (81%), the extent of PSC significantly correlated with the dose to the lens receiving 10, 26, and 47 Gy (P = .03, P = .03, and P = .04, respectively), the dose to the lens periphery receiving 10 and 26 Gy (P = .02 and P = .02, respectively), and the dose to the ciliary body receiving 10 and 26 Gy (P = .03 and P = .02, respectively). Nuclear color significantly correlated with the dose to the ciliary body receiving 10 Gy (P = .03) and 26 Gy (P = .02). After adjustment of the results on tumor volume and tumor location, the volume of lens receiving 10 Gy (P = .04) and 26 Gy (P = .03) remained significantly associated with the extent of PSC.

CONCLUSIONS

Proton dose correlated with the occurrence of PSC and nuclear color cataracts as defined by LOCS III grading. Better characterization of cataracts with the LOCS III after irradiation may help to further fill gaps in the current understanding of the mechanisms of radiation-induced cataracts.